影响肺癌患者治疗依从性的社会人口学及临床因素分析

Analysis of sociodemographic and clinical factors influencing the treatment compliance of patients with lung cancer

目的调查影响肺癌患者治疗依从性的社会人口学及临床因素。方法以2013年1月至2017年12月粤北人民医院新诊断为肺癌且可能从抗肿瘤治疗获益的患者为研究对象。依据是否接受抗肿瘤治疗进行分组,分析接受和拒绝治疗患者的社会人口学及临床特征。随后,通过倾向匹配队列研究进行生存分析,评估拒绝治疗对患者生存率的影响。结果共纳入2794例患者,其中1225例(43.84%)未接受抗肿瘤治疗。2013-2017年,未接受治疗患者占比无减少趋势,这对预后有显著的负面影响。分析显示,相对低龄(OR=0.64,95%CI:0.59~0.70)、小细胞肺癌(OR=1.83,95%CI:1.40~2.40)、腺癌(OR=1.69,95%CI:1.39~2.07)、肿瘤分期早(OR=0.55,95%CI:0.49~0.60)、城镇职工医保(OR=2.01,95%CI1.63~2.49)、居住地距医院近(OR=0.82,95%CI:0.76~0.87)的患者依从性较好,而高龄、病理类型不确定(OR=0.18,95%CI:0.12~0.26)、肿瘤分期晚、城镇居民医保、居住地距医院较远的患者拒绝治疗可能性大。治疗的副作用、经济问题及缺乏陪护人员是患者拒绝治疗最常见的原因。结论为了实现医疗公平和改善肺癌患者预后,临床及社会人口学问题都应关注。

Objective This research tried to investigate the sociodemographic and clinical factorsthat influencing treatment compliance of patients with lung cancer.Methods We reviewed all data of prospective anti-tumor therapy candidates with lung cancer in Yue Bei People’s Hospital from January 2013 to December 2017.Sociodemographic and clinical characteristics between patients who opted for anti-tumor therapy and those who declined were analyzed.Subsequently,adjusted survival analysis was performed on propensity-matched cohorts.Results A total of 2794 patients with lung cancer were recommended for anti-tumor therapy during the 5 years and 1225(43.84%)rejected.No trend of reduction in the ratio of rejection of anti-tumor therapy was observed from year 2013 to 2017,which had a significant impact on survival of patients.On multivariate analysis,younger age(OR=0.64,95%CI:0.59~0.70),small cell lung cancer(OR=1.83,95%CI:1.40~2.40),adenocarcinoma(OR=1.69,95%CI:1.39~2.07),earlier tumor staging(OR=0.55,95%CI:0.49~0.60),covered by Urban Employees’Basic Medical Insurance(OR=2.01,95%CI:1.63~2.49)and shorter geographical distance to hospital(OR=0.82,95%CI:0.76~0.87)were independently associated with acceptance for anti-tumor therapy.Inversely,older age,uncertain pathological type(OR=0.18,95%CI:0.12~0.26),advanced tumor staging,covered by Urban Residents’Basic Medical Insurance and longer geographical distance to hospital prone to rejection of anti-tumor therapy.The top three reasons for rejection of anti-tumor therapy were fear of side effects of treatment,financial issues and lack of caregiver.Conclusion To achieve equity in healthcare and improve the prognosis of lung cancer,both of clinical and sociodemographic problems should be concerned.